SHAREHOLDING AND BENEFICIAL OWNERSHIP DECLARATION

The Financial Intelligence Centre Act 38 2001 (FICA) requires sefa as accountable institution to
establish who the beneficial owner of the legal person and take reasonable steps to verify the
identity of the beneficial owners.

Important Notes
This form requires you to provide the name, address, ID number of the following individuals:
1. Each individual, if any, who owns, directly or indirectly, 25% or more of the equity
interests of the legal entity {customer} (e.g., each natural person that owns 25% or more
of the shares of a company); and

2. An individual with significant responsibility for managing the legal entity customer (e.g.
Chief Executive Officer, Chief Financial Officer, Chief Operating Officer, Managing
Members, Partners, Trustees and Directors).

SECTION A - CLIENT INFORMATION

Persons acting on behalf of a legal entity must provide the following information:

1. Name and Title of Natural Person Acting on behalf of the client:

Title: Mrs.

Name: Nomapelo Pamella Nyokana

2. Name and Address of Legal Entity: Siba and Tutuse (Pty) Ltd
2086 De Wet street, Extension 3, Margate, 4275

Registration Number:
2017/433773/07

3. Contact Number: Email Address:(if available)

082 437 6208 siba.legacytransport@gmail.com
_______________________ ___________________________

Small Enterprise Finance Agency (SoC) Ltd, Registration Number 1995/011258/06 is a Licensed Credit Provider • NCRCP 160
1. SHAREHOLDERS WHO ARE NATURAL PERSON WITH 25% OR MORE SHAREHOLDING

Name and Surname Identity/ Passport Residential Voting

Number Address/Operating Address Rights/Shareholding
%
Nomapelo Nyokana 7010151056084 2086 De Wet str. Ext. 3 100%
Margate 4275

*Repeat as required

For all shareholdings listed above, please provide:

o Identity documents/Passport (if natural
person)
o Proof of residential address

2. LEGAL ENTITIES WHO HAVE 25% OR MORE SHAREHOLDING

Name of a Legal Company Company Registration Voting

Entity Registration Number Address Rights/Shareholding
%

N/A N/A N/A N/A

For all shareholdings listed above, please provide:

o Incorporation document containing directors

o Proof of operating address of the entity

If the client (legal entity) has shareholders with 25% or more shareholding, please
provide:
o Organizational chart displaying ownership
structures
3. EXCHANGE LISTED LEGAL ENTITY WITH 25% SHAREHOLDING OR MORE

If your legal entity is listed on a stock exchange

Name of the legal entity: __________________________

N/A
Name of the exchange: __________________________

Company Registration Number:______________________

% of shareholding

* We require written confirmation of the registered name, registration number and

physical address (verification documentation is not required)

4. COMPLETED BY

Nomapelo Pamella Nyokana

I, _________________________________________ (name of natural person
authorized to sign on behalf of the client), hereby certify, to the best of my knowledge
that the information provided above is complete and correct.

Designation Director Other: _________N/A_________________________

082 437 6208 siba.legacytransport@gmail.com

Contact Number: ____________________ Email Address: ________________________

Signature: __________________ Date: 4 June 2024